Abstracts

Rationale: Skin irritation is a known but underreported complication of EEG monitoring. While there is increasing national concern around this issue, there is limited data about the mechanism, risk factors, and incidence of such complications. The objective of this study is to identify the incidence of and potential risk factors contributing to skin injury during continuous EEG (cEEG) recordings.Methods: Two year cross-sectional study of patients admitted to Children’s National undergoing cEEG monitoring who developed skin breakdown at electrode sites. Wet electrodes were applied conventionally in the International 10-20 positions (reduced electrode set for neonatal) using skin abrasion with Nuprep (Weaver & Co., Aurora, CO) and LemonPrepTM (Madivon Corp., Lake Worth, FL), and filled with Ten20 (Weaver& Co., Aurora, CO) conductive paste then wrapped lightly with gauze. Our Wound Team is typically contacted for a disruption of skin integrity greater than a Stage 1 pressure ulcer or for any other concerning skin lesions. Patients were identified from a Wound Team consult log. Clinical variables examined include: age, hospital location, active infection, nutritional status, coagulopathies (coag), cEEG duration, concurrent therapeutic hypothermia (TH), allergies (All), and skin issues. Risk for skin breakdown was examined for all EEGs, EEGs performed per hospital location (non-ICU, all ICUs, NICU, CICU, PICU) and compared relative to the risk of a single day of EEG in a non-ICU patient. Chi square test was used to determine p values.Results: 7920 patients received cEEG between 2013-2015: Non-ICU (N=6116) NICU (N=500), CICU (N=202), PICU (N=1102). (see Figure 2) Median cumulative duration of cEEG was 1 day (30 minutes to 29 days). Skin injury, ranging from scalp excoriation to deep tissue injury occurred in 7 patients (0.09%, Figure 3). ICU patients had a higher incidence of skin injury compared to non-ICU patients (0.28% vs 0.03%, p=0.002), in particular NICU patients (0.6%, p<0.001) and CICU patients (05%, p=0.003). PICU patients were not at increased risk. EEGs performed greater than 1 day in an ICU patient (OR 10.28, p=0.04) or greater than 2 days in any location had higher risk of skin breakdown (OR 68.08, p<0.0001). Six of the 7 patients had the following clinical risk factors: fever or sepsis; NPO at time of cEEG; coagulopathies with INR >1.35; >3 days of cEEG recording.Conclusions: Skin injury due to cEEG is a rare occurrence at our institution. Critical illness and prolonged cEEG recordings are common in patients with skin injury. Limitations of the study include a selection bias for more significant skin injuries since the Wound Team is not typically consulted for skin erythema (Stage 1 PU).